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A STATISTICAL STUDY 



OF 



INFANT MORTALITY 



EDWARD BUNNELL PHELPS, M.A., F.S.S. 
Editor, The American Underwriter, of New York City 



Reprinted from the Quarterly Publications of the American Statistical Association 
New Series, No. 83 (Vol. XI.), September, 1908 









Gift 
Author 



A STATISTICAL STUDY 



OF 



INFANT MORTALITY 



Considerably more than a generation ago (in 1865), Dr. Farr 
brought the subject of Infant Mortality before the [Royal] 
Statistical Society, and frequently discussed it in his historic 
contributions to the annual reports of the Registrar-General's 
office. On December 19, 1893, Dr. Hugh R. Jones read before 
the Royal Statistical Society an exhaustive paper on "The 
Perils and Protection of Infant Life," which had the distinction 
of being the Howard Medal Prize Essay of that year. In the 
interim of more than forty years since Dr. Farr inaugurated the 
statistical discussion, so to speak, infant mortality has been a 
prolific subject in medical works and journals, has received 
perennial treatment in the reports of practically all bureaus of 
vital statistics, and the bibliography of the subject even up to 
ten years ago would constitute quite an impressive library, 
were all the papers on, and extended references to, this partic- 
ular phase of human mortality assembled and properly indexed. 

In a general way, however, it may be said that only within the 
last few years has the topic been presented in such a light as 
to attract serious attention at the hands of the public at large, 
the discussion up to the end of the nineteenth century having 
practically been restricted to medical men, government officials, 
and professional statisticians. To be sure, as early as 1876 a 
Society for Nursing Mothers was established in France, and pro- 



vision thus made on a small scale for caring for destitute mothers 
immediately before and after childbirth. The Creches of France 
and the Krippen of Germany, or day nurseries, in part supported 
by private charity and in part by State or municipal aid, long 
since became well-known institutions. For many years both 
Germany and Switzerland have had laws prohibiting women 
from working in factories for certain periods before and after 
confinement, and providing for their partial support during 
those periods of compulsory idleness; and Section 61 of the 
Factory and Workshop Act (of 1901) of Great Britain enjoins 
factory employers from knowingly allowing women to work in 
their factories within four weeks of childbirth. 

Furthermore, some fifteen years ago Nathan Straus began the 
establishment of his milk depots in New York City with a view 
to supplying pasteurized milk at nominal price for children's use, 
and since then the plan introduced by Mr. Straus has been 
copied in various quarters. But all of these institutions of 
nineteenth-century origin were the outcomes of individual reali- 
zation of the growing importance of the problem of infant 
mortality, rather than of a public appreciation of its far-reaching 
bearing on the future of the race, and their establishment in no 
way controverts the previous statement that practically only 
since the dawn of the twentieth century has the subject been 
so brought forward as to attract serious attention at the hands 
of the thinking public. 

The fact that such an era has now arrived is due to a variety 
of causes. In the first place, even the most pronounced cynic, 
if he be a well-informed and reasoning person, must admit that 
the community at large has begun to take more interest than 
ever before in "how the other half fives." So obvious and 
indisputable a truth calls for no demonstration, and the grow- 
ing interest in "how the other half dies" is an inevitable corol- 
lary of the ascending interest in how the unfortunate or less 
fortunate section of the community fives. Perhaps this gen- 
eral development of the humanitarian instinct is primarily 
responsible for the civilized world's awakening to the appalling 
conditions of infant mortality. Men are beginning to realize 



that the caste lines once so rigidly drawn between the various 
classes are, like most national boundaries in one sense at least, 
purely imaginary lines, and that the health and welfare of any 
one section of the community directly concern the health and 
welfare of the community at large. As Dr. Margaret Alden so 
well puts it in her very recent work on "Child Life and Labour," 
in the chapter on infant mortality (p. 16) : "A thorough under- 
standing of the subject should be the concern of every true 
citizen for three reasons: 1. Because such a wastage of human 
life is a loss of the nation's best capital. 2. Because the con- 
ditions which make for the death of infants, make also for dis- 
ease. 3. Because this question appeals to us on humanitarian 
grounds." 

By way of secondary, indirect, cause for the general dawning 
interest in the subject, probably the material advance in medi- 
cal knowledge and in established principles of hygiene and 
sanitation has played the most important part. As an immedi- 
ate result of this advance has come the gradual decrease in the 
general death-rate of recent years in practically all civilized 
countries, but as Dr. George Reid, Medical Officer to the Staf- 
fordshire County Council, points out in his contribution to the 
cyclopedic work on "Dangerous Trades" in the paper on "In- 
fantile Mortality and Factory Labour" (pp. 84^85) : "Although a 
steady decline has taken place in the general mortality of the 
country coincident with, and, no doubt, in the main, consequent 
upon sanitary progress, it cannot be said that the infant mortal- 
ity has diminished in like proportion." That fact has been so 
generally noted, and so repeatedly emphasized, by both physi- 
cians and statisticians, that it could scarcely have failed to make 
at least some impression on the public mind. And now that 
it has been so graphically stated, as, for instance, in H. Llewel- 
lyn Heath's recent book on "The Infant, the Parent, and the 
State," small wonder is it that thoughtful people of all classes 
are beginning to realize that it is high time some united action 
were taken with a view to devising remedies for so anomalous 
a situation. 

Mr. Heath's indirect indictment of the previous apathy on 



4 

the subject, on the first page of his book, is put in this blunt 
way: "In the year 1904, England lost 137,392 of her children 
before they had reached the short span of twelve months of life. 
The deaths of these infants constituted 25 per cent, of all the 
deaths in England and Wales during the year we are consider- 
ing. Geneva has kept registers of births, marriages, and deaths 
since 1549. In the sixteenth century their infant deaths con- 
stituted 25.9 per cent, of their total deaths at all ages." In 
other words, as Mr. Heath thus makes clear, despite all the 
hygienic and sanitary progress of modern times, and despite the 
marked decline in the general death-rate, the ratio of infant 
mortality to total mortality remains practically the same in 
England and Wales to-day as it was in Geneva nearly three 
hundred and fifty years ago; and, it might be added, present 
conditions in the United States are only slightly better, the 
ratio of infant deaths to deaths at all ages in the registration 
States of this country in the last census year, as is shown in one 
of the tables accompanying this paper, having been no less than 
20.06 per cent, as compared with Geneva's percentage of 25.9 
more than three centuries ago. 

The general tendencies in the direction of an increased public 
interest in the subject of infant mortality, above briefly outlined, 
of course have been materially supplemented and intelligently 
directed by the more or less frequent contributions to the discus- 
sion of Dr. Farr, Dr. Bertillon, Dr. Newsholme, Sir John Simon, 
Dr. Greenhow, Dr. Reid, Dr. Newman, and other statisticians 
and physicians; and so it happens that in the last three years 
no less than five congresses have been held in various European 
countries with a view to grappling seriously with the problems 
of infant mortality. The first of the five in question was an 
International Congress on the Functions of Infants' Milk 
Depots, which was held in Paris in October, 1905. The mayor 
of Huddersfield, the chairman of the Health Committee of 
Glasgow, and various other representatives from Great Britain 
attended the congress, and as the immediate result of their 
attendance a National Conference on Infantile Mortality was 
held at Westminster, on June 13-14, 1906. A complete steno- 



graphic report of the proceedings of that conference has been 
published (London, 1906), and the demand for copies from all 
parts of the world was so unexpectedly large that the first edition 
of 3,000 copies was speedily exhausted, and a second edition 
made necessary. 

In the preface to the second edition the Executive Commit- 
tee thus summarizes the former apathy and the present general 
interest in infant mortality above alluded to: "The Conference 
of 1906 was the first attempt to bring before the public one of 
the most important of the many aspects of the social problem 
of physical and social degeneration. Prior to the Conference 
the problem of the appalling death-rate of infants under one 
year attracted only the attention of medical men — and merely 
a small proportion of that profession — and of a few philan- 
thropists and social reformers, and the Executive Committee, 
who organized the Conference of 1906, hardly ventured to hope 
that their efforts would result in one of the most successful 
conferences, from a public health and social reform point of view, 
which has been held in this country." The conference was 
held in the rooms of the Westminster City Council, under 
the patronage of their Majesties King Edward VII. and Queen 
Alexandra. The Right Hon. John Burns, M.P., president of the 
Local Government Board, presided; and the chairman and vice- 
chairman, respectively, were Alderman Evan Spicer, M.P., 
chairman of the London County Council, and the Hon. Lord 
Provost of Glasgow, William Bilsland, Esq. The Lord Mayors 
of Liverpool, Manchester, Leeds, York, and Belfast, the Lord 
Provosts of Glasgow, Edinburgh, and Aberdeen, various other 
governmental officials, and some of the foremost medical 
officials of Great Britain served as vice-presidents of the con- 
ference, and the enlistment of these notables gave a decided 
impetus to the new movement. A second National Con- 
ference on Infantile Mortality, with an even more distinguished 
list of vice-presidents and delegates, was held at Westminster, 
March 23, 24, 25, 1908, and, largely as a result of the previous 
conference, the Notification of Births Act of 1907 was adopted 
by Parliament. A complete report of the proceedings and 



papers of the second conference was also published (London, 
1908). 

Practically simultaneous with the first National Conference 
at Westminster, an exposition was held at Berlin for the pur- 
pose of inaugurating a comprehensive study of all the various 
phases of the infant mortality problem, and some idea of the 
scope of its work may be gained from the mere announcement 
that the exposition was continued for nearly three weeks. In 
its issue of Oct. 13, 1906, Charities and the Commons presents 
a summary of the work of the exposition, in part as follows: 
"Accompanying the exhibits were exhaustive explanatory 
leaflets and monographs by the most celebrated specialists, and 
a catalogue containing every possible and minute detail to 
instruct and enlighten. A bare outline even of the rich mass of 
material presented would go far beyond the limits of our space, 
and give subjects for numbers of articles. The striking feature 
of the exhibit is the increasing solicitude of governments to 
concern themselves in questions affecting the well-being and 
happiness of people, and the rapidly increasing co-ordination 
between private, or voluntary, and civic and national, or au- 
thoritative, reforms. The conditions of infant mortality in 
the German Empire have for a long time and with reason been 
the cause of grave anxiety to German social and political scien- 
tists, since statistics have been showing that, of the 2,000,000 
infants born annually, 400,000, or one-fifth, do not survive 
the first year of existence. This disquieting fact has given rise 
to the founding of an institute, where, as a central point for the 
whole empire, the subject of infant mortality, its direct and 
accessory causes, will be studied with a seriousness worthy of the 
subject, and with all the co-ordinated thoroughness and science 
known to the German municipality and the German medical 
profession. From the side of medicine is to be given the fullest 
inquiry into physiological, and from the municipality into social, 
contributing causes." 

In September, 1907, an international conference on the sub- 
ject was held at Brussels, under the name of the Second Inter- 
national Congress of Gouttes de Lait, and it was decided that 



its scope should be extended, and that the next congress should 
be termed the International Congress for the Protection of 
Infant Life. Were any further evidence of the increasing 
interest in the subject necessary, it possibly might be supplied 
by citing the fact that the subject selected by the Council of 
the Royal Statistical Society for essays in competition for 
the Howard Medal in 1908-09 is: "A Statistical Study of In- 
fantile Mortality in Great Britain and Ireland, and of its 
Causes." 

Even this brief summation of recent movements — move- 
ments international, governmental, and statistical — in the 
direction of trying to discover some means of coping with the 
substantially stable death-rate among young children the 
world around, makes it evident, it seems to the writer, that the 
subject of infant mortality has at last begun to impress its 
importance upon the thinking element of the civilized world, 
and will unquestionably receive more and more attention in 
the next few years. In view of that fact a review of the sub- 
ject from an up-to-date statistical stand-point may not be inop- 
portune. As above noted, the compilation of vital statistics 
in Geneva dates back to 1549, and it might almost be said that 
from that time down to date there have been more or less com- 
plete compilations of the statistics of infant mortality. In 
England local statistics on those lines are practically co-ex- 
istent with the Registrar-General's office, the Massachusetts 
statistics of infant mortality for an even half-century are pre- 
sented in a table accompanying this paper, and about eighteen 
years ago Dr. Jacques Bertillon prepared for the Encyclo- 
pedic d'Hygiene et de Medecine Publique a compilation of 
infant mortality statistics for the various countries of Europe, 
dating back as far as 1862 in one case. 

The annual reports of the Registrar-General's office contain 
abstracts of the infant mortality rates of all the leading coun- 
tries of the world, substantially down to date, and Dr. George 
Newman's recent work on " Infant Mortality — A Social Prob- 
lem," contains a mass of statistical information reprinted from 
various sources. The Tenth, Eleventh, and Twelfth Census 



8 

Reports, and the three subsequent Special Reports of the 
Census Office inaugurating the prospective annual reports of 
mortality statistics of this country, present a great array of 
information — such as it is — regarding deaths of children under 
the ages of 1 and 5 in the United States, and the reports of all 
the countries and States having bureaus of vital statistics also 
contain more or less data along these lines. Consequently, 
there has been no lack of infant mortality statistics for the 
last fifty years and more, but, so far as the writer is aware, 
there has been no previous accumulation of this widely scattered 
information in such a way as to permit of any reasonably 
accurate, up-to-date, international comparisons of the mortality 
among infants. As subsequently noted, the statistics of the 
United States at large are wofully defective, and in the case of 
nearly all the registration States the margin of error is unques- 
tionably a wide one, but by means of various methods of com- 
parison an effort has been made to reduce the statistics of this 
country to a fairly accurate basis, and it is hoped that a work- 
able plan of contrasting the infant mortality rates of the United 
States and other countries has been found. Unless otherwise 
specified, the term " infant mortality rate," wherever used in 
this paper, is to be construed as invariably referring to the rate 
of deaths under 1 year per 1,000 births — still-births excluded. 

The table of Dr. Bertillon, above mentioned, is generally 
recognized as the earliest fairly accurate summary of the infant 
death-rate in Europe, and perhaps may best serve as the start- 
ing-point of this statistical review of the subject. Under the 
heading of "Tableau LXXXIII, Mortalite de a 5 ans dans 
les principaux pays de l'Europe," it appears in Bertillon's 
chapter on " Demographie " in the Encyclopedic d'Hygiene 
(vol. i, p. 254), and, rearranged so as to present the various 
European countries in the order of their several death-rates 
under age 1, is as herewith reproduced. In its original form 
the table presents the supposed figures of the late '70's for 
Massachusetts, Rhode Island, and Vermont, which are omitted 
in the appended transposed reprint. 



TABLE I. 



Mortality from to 1 and to 5 Years in the Principal Countries of 
Europe Prior to 1883, according to the Bertillon Table. 



Countries. 



Period of 
Observation. 



Of 1,000 
Born Alive, 
Died under 

1 Year. 



Of 1,000 
Born Alive, 
Died under 

5 Years. 



Ireland 

Norway 

Scotland . . . . ' . 

Sweden 

Denmark .... 

Greece 

Belgium 

England and Wales 

Portugal 

Finland 

France 

The Netherlands . 
Switzerland . . . 

Prussia 

Italy 

Alsace-Lorraine . . 

Croatia 

Roumania .... 

Austria 

Baden 

Russia in Europe . 

Saxony 

Bavaria 

Wiirtemberg . . . 



1865-83 

1866-82 

1865-81 

1866-82 

1870-82 

1878-82 

1867-83 

1866-82 

1862 

1878-80 

1875-82 

1878-81 

1869-80 

1874^82 

1872-83 

1872-81 

1874^-82 

1875-82 

1866-83 

1866-83 

1867-78 

1865-70 

1866-83 

1871-81 



95.9 
104.9 
122.0 
131.9 
137.5 
137.7 
148.2 
149.2 
150.0 
164.9 
166.2 
193.2 
195.2 
207.8 
209.7 
212.7 
234.0 
250.0 
255.3 
261.7 
266.8 
270.0 
308.4 
312.5 



164.6 
179.1 
230.9 
222.5 
204.9 
264.5 
253.2 
249.3 



251.1 

266.3 
316.2 
378.5 
298.0 
423.8 
339 6 
389.9 
346.9 
422.9 
373.5 
393.2 
397.1 



The totals are not given with the tabulation as presented 
by Bertillon, but, dividing the total of 4,685.7 deaths under 
age 1 for 24 countries and the total of 6,366.0 deaths under 
age 5 for 21 countries, it appears that the averages for the 
European countries in the period stated were 195.2 for deaths 
under age 1 and 303.1 for deaths under age 5. In a general 
way, such were the infant death-rates of Europe a generation 
ago, if the returns on which Bertillon's table was based were 
correct. The question which naturally follows a study of them 
is: How have the infant death-rates of the intervening years 
compared with those of from thirty to forty years ago, in view 
of all the humanitarian, hygienic, and medical developments 
of this latter period ? In the main, the conditions favorable to 



10 

better health, and a reduced death-rate, have materially im- 
proved. Has there been a corresponding improvement in the 
general health of infants, and a corresponding decrease in 
the death-rate of the little ones? Only the official vital sta- 
tistics of the various countries can answer those questions, 
and, as the following tables will demonstrate, the answer is a 
sadly disappointing one. 

The first attempt of any importance to assemble information 
on these lines, subsequent to the preparation in 1890 of the 
Bertillon table above reproduced, was made by Dr. Julius 
Eross, and its results embodied in a paper presented before 
the Section for Children-Hygiene of the International Congresses 
for Hygiene and Demography at Budapest in 1894, under the 
title of "Ueber die Sterblichkeitsverhaltnisse der Neugeborenen 
und Sauglinge." The text and tables of Dr. Eross's paper were 
subsequently published in the Zeitschrift fur Hygiene und Infec- 
tionskrankheiten, the important work periodically published at 
Leipzig under the editorial direction of Dr. Robert Koch and 
Dr. C. Fliigge, and the statistics therein presented form a con- 
necting link, as it were, between those of the Bertillon table 
and the infant mortality figures up to 1905 especially compiled 
by the writer for this paper, and presented in subsequent tables. 
The statistical data of Dr. Eross's paper as published in the 
Zeitschrift (vol. xix, pp. 371-392) begin with Table I (p. 372), 
showing the " Infant Mortality of 0-1 Year at Rate of the Living 
Born and the Total Mortality in Thirteen European States," 
which, we are informed, was compiled from the various statis- 
tical year books. Translating its percentage ratios into rates 
per 1,000, for the sake of conformity with all the other tabula- 
tions of this paper, and taking the liberty of substituting in 
the list of countries for the name of Sweden that of Norway, 
which investigation of the official figures for both countries 
proves to have been the country with which the figures given 
for Sweden were identified, the table is as follows: — 



11 



TABLE II. 

Bihths, Deaths under Age 1, Total Deaths, and Infant Mortality Rates per 1,000 
Births and per 1,000 Total Deaths, Still-births excluded, in Thirteen of 
the Principal European Countries, according to Dr. Eross's Table. 



Countries and Periods. 


Number of 
Living 
Births. 


Died 
under 
1 Year. 


Rate 

per 

1,000 

Births. 


Total 
Mortality. 


Rate of 

Deaths 

under 1 

per 1,000 

Total 
Deaths. 


Ireland 1884-88 

Norway 1881-90 

Scotland 1885-90 

England (and Wales) 1885-91 

Belgium 1881-91 

France 1885-90 

„ „ , ( 1880-82 1 

HoUand J 1885-90 i 

Italy 1884-91 

Prussia 1886-92 

Hungary 1884-87 

Austria 1886-87 

Saxony 1886-92 

Bavaria 1879-88 


570,710 

600,489 

745,986 

6,234,373 

1,940,197 

5,337,880 

1,332,266 

8,980,579 
7,681,839 
2,641,797 
1,765,541 
987,248 
2,014,195 


54,049 

58,471 

89,858 

900,310 

309,766 

882,909 

239,466 

1,727,067 

1,594,039 

560,220 

435,763 

277,857 
579,203 


94 
97 
120 
144 
159 
165 

179 

192 
207 
212 
246 

281 

287 


439,635 

331,209 

446,179 

3,770,281 

1,325,696 

5,049,223 

817,216 

6,420,910 
4,622,216 
1,912,419 
1,350,760 
639,208 
1,535,781 


123 
176 
213 
238 
233 
174 

293 

268 
344 
292 
322 
434 
376 


Totals 


40,833,100 


7,708,978 


183 


28,660,733 


269 







The periods of observation whose returns are presented in 
the above table in all cases overlap on the period with which 
the subsequent table for the last twenty-five years deals, and 
no detailed analysis of the tabulation of Dr. Eross is necessary 
at this point, as its lessons are brought out with intensified 
force in the later table. That is to say, in this case, as in all 
cases, the greater includes the less. It may, however, be 
remarked, en 'passant, that all the countries included in the 
above table were also named in the Bertillon table, with the 
single exception of Hungary, and that the average infant mor- 
tality rate per 1,000 living births in those twelve countries in 
the period covered by Bertillon's table was 186, as compared 
with 187 in the period with which Dr. Eross dealt. This 
startling inflexibility of infant mortality rates, when measured 
by broad averages of either countries or periods, is discussed 
at some length on subsequent pages of this paper. 



12 



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For many years the annual reports of the Registrar-General 
have presented the most compact abstracts anywhere obtain- 
able of the birth-rates, marriage-rates, death-rates, and death- 
rates under 1 year to each 1,000 children born, in practically all 
the European countries — and certain countries in other sec- 
tions of the world. Taking those tables in the current (sixty- 
ninth) annual report as a basis, the writer has prepared the 
following tabulation, which affords a comprehensive picture of 
the infant mortality experience of the principal countries of 
Europe and Australasia for the last quarter of a century. The 
Registrar-General's report announces that in each case the 
figures were obtained from the statistical department of the 
country named, and that still-births have been eliminated 
in the case of both births and deaths, and in the preparation 
of the following tabulation the birth-rates and infantile death- 
rates for each five-year period named have been obtained by 
adding the rates for the 5 years and dividing the totals by 5. 
The general averages for the entire period under observation 
have been deduced by adding all the annual rates given in each 
case, and dividing the total by the number of years which each 
total represents. Had the actual numbers of births and deaths 
for each year for each country been available — as was the case 
with the restricted table of Dr. Eross — instead of the birth- 
rates and death-rates, the five-year and total averages of course 
would have been slightly more exact, but the death figures are 
not given in the Registrar-General's returns from other coun- 
tries, and, doubtless, the margin of error is so narrow as to 
be practically inappreciable. So explained, the tabulation in 
question speaks for itself, and is as follows: — 



TABLE III. 

Birth-rates, and Death-rates under Age 1 per 1,000 Births, of the Principal Foreign 
Countries for the Last Twenty-five tears, by Five-year Periods and for the Entire 
Twenty-five Year Period — Still-births excluded in Both Cases. 





1881-85. 


1886-90. 


1891-95. 


1896- 


-1900. 


190] 


-05. 


Averages . 
1881-1905. 


Countries. 


o 

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0,3 

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o 
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TH O 

03 

m ft 
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R ft 


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1-1 .2 
1-1 "§ 

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m n 

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31.2 


99 


30.8 


96 


30.2 


98 


30.2 


96 


28.6 


81 


30.2 


04 




23.9 


94 


22.8 


95 


23.0 


102 


23.3 


106 


23.2 


98 


23.2 


99 




29.4 


116 


28.8 


105 


27.5 


103 


26.9 


101 


26.1 


92* 


27.7 


104* 




37.0 


81 


36.1 


95 


37.7 


140 


41.3 


143 


40.9 


145* 


38.6 


120* 




33.3 


117 


31.4 


121 


30.5 


126 


30.0 


129 


28.9 


120 


30.8 


123 




32.4 


134 


31.5 


137 


30.4 


139 


30.0 


132 


29.0 


119 


30.7 


132 




35.5 


162 


34.5 


144 


31.8 


145 


32.6 


139 


31.4 


131 


33.2 


144 


England and Wales, 


33.5 


139 


31.4 


145 


30.5 


151 


29.3 


156 


28.1 


138 


30.6 


146 


Switzerland .... 


28.6 


171 


27.5 


159 


27.7 


155 


28.5 


143 


28.1 


134 


28.1 


153 


Belgium 


31.1 


156 


29.5 


163 


29.2 


164 


28.9 


158 


27.7 


148 


29.3 


158 




46.3 


157 


43.7 


158 


43.3 


172 


40.0 


159 


38.8 


149 


42.4 


159 




24.7 


167 


23.1 


166 


22.3 


171 


22.0 


159 


21.3 


139 


22.7 


160 


The Netherlands . . 


34.8 


181 


33.6 


175 


32.8 


165 


32.1 


151 


31.6 


136 


33.0 


162 




38.0 


175 


37.5 


175 


36.1 


185 


34.0 


168 


32.6 


168 


35.6 


175* 




36.4 


193 


36.0 


186* 


35.3 


185 


34.3 


185 


35.3 


173 


35.5 


185* 




37.4 


207 


37.3 


208 


37.0 


205 


36.5 


201 


34.9 


190 


36.6 


202 


Roumania .... 


41.8 


182 


40.9 


195 


41.0 


220 


40.2 


216* 


39.4 


203 


40.7 


203* 




38.2 


223 


37.8 


223 


37.5 


223 


37.3 


226 


35.6 


213* 


37.3 


223* 




44.4 


226 


43.5 


226 


41.7 


250 


39.4 


219 


37.2 


212 


41.2 


226* 


Russia in Europe 


49.1 


271 


48.2 


264 


48.2 


276 


49.3 


261 


48.6 


268 


48.6* 


268* 


Averages for Europe, 


35.3 


163 


34.3 


162 


33.7 


169 


33.3 


162 


32.4 


153 


33.8 


162 


New Zealand . . . 


36.3 


90 


31.2 


84 


27.7 


87 


25.7 


80 


26.6 


75 


29.5 


83 




34.5 


109 


34.6 


103 


32.7 


94 


28.2 


98 


29.0 


90 


31.9 


99 


South Australia . . 


38.5 


101 


34.7 


105 


32.0 


99 


27.0 


112 


24.5 


87 


31.3 


101* 


Queensland .... 


36.5 


136 


37.4 


119 


34.1 


103 


29.2 


104 


26.7 


95 


32.8 


111 


New South Wales . 


37.7 


124 


36.4 


115 


32.9 


111 


28.0 


113 


26.7 


97 


32.3 


112 


Victoria 


30.8 


122 


32.7 


131 


31.0 


111 


26.2 


111 


24.9 


96 


29.1 


114 


Western Australia . 


34.5 


135 


37.0 


123 


31.4 


130 


27.9 


160 


30.3 


126 


32.2 


135* 


Averages for Austral- 




























35.5 


117 


34.9 


111 


31.7 


105 


27.5 


111 


27.0 


95 


31.3 


108 


Japan 


26.0 


104 


28.5 


116 


28.6 


147 


31.1 


153 


31.8 


154 


29.2 


135 




28.6 


158 


30.2 


158 


31.7 


169 


37.1 


168 


38.6 


171 


33.2 


165 




37.6 


158 


36.7 


170 


38.4 


171 


38.9 


175 


39.0 


174 


38.1 


169 


Chili 


39.4 


314 


35.2 


264 


37.2 


336 


34.1 


333 


35.2 


332* 


36.2 


314* 


Averages for Coun- 


























tries Named . . . 


32.9 


184 


32.7 


177 


34.0 


206 


35.3 


207 


36.2 


208 


34.2 


196 



Recapitulation. 



Australasia .... 
Other Lands . . . 


35.3 
35.5 
32.9 

35.1 


163 

117 
184 


34.3 
34.9 

32.7 


162 
111 
177 


33.7 
31.7 
34.0 


169 
105 
206 


33.3 
27.5 
35.3 


162 
111 
207 


32.4 
27.0 
36.2 


153 

95 

208 


33.8 
31.3 
34.2 


162 
108 
196 


fGrand Averages 


155 


34.2 


152 


33.3 


159 


32.2 


157 


31.6 


147 


33.3 


154 



* Returns for one or more years wanting, and averages have been calculated on basis of 
returns for other years of period in question. 

t Computed by division of totals for all countries represented in table by number of 
countries in question. 

Italicized figures represent estimates for periods for which no returns were available, estimate 
in each case being average of actual returns for balance of entire twenty-five year period. 



15 



So far as the writer is aware, the preceding table is the first 
detailed comparison ever compiled of the birth-rates and infan- 
tile death-rates of the leading countries of the world by five- 
year periods for an entire quarter of a century, and the con- 
tinuity of comparisons sheds considerable light on many 
mooted questions which have been raised in the protracted 
discussion of infant mortality. Unfortunately, in a few cases 
returns were wanting, and in order to round out the averages 
for the periods and countries in question it was necessary to 
substitute estimates for actual returns. As stated in the ap- 
pended foot-note, however, all estimates for five-year periods 
were based on the averages of returns for the balance of the 
twenty-five year period, and the margin of error, therefore, 
is probably so slight as to make no material difference in the 
general showing. 

The first and all-important point to be noted in the tabula- 
tion is the uniformity of the infantile death-rate for the world 
at large for the last quarter of a century, and its comparatively 
slight fluctuations by five-year periods in particular countries 
or sections of the world. Thus it will be noted, in the thirty- 
one widely remote countries for which returns are presented, 
in 1881-85 the rate of infant deaths per 1,000 births was 155, and 
in the period terminating twenty years later was practically 
identical, then standing at 154. As is shown by a subsequent 
table herein presented, the apparent infantile death-rate in 
this country in the States recognized as registration States 
at the time of the Twelfth Census was 144.7 in 1900 and 162.6 
in 1890, thus averaging 153.7; and, as is demonstrated by 
another table showing the annual infant mortality rates in 
Massachusetts from 1856 to 1905, the average infant death- 
rate under age 1 per 1,000 living births in that Commonwealth 
for the last fifty years has been 152.4. Succinctly stated, the 
infantile death-rates for these various sections and periods were 
as follows: — 



16 



TABLE IV. 

The Uniformity of the Infantile Death-rate in All Sections of the World in 

Recent Years. 



Sections. 


Periods of 
Observation. 


Deaths under 

Age 1 per 
1,000 Births. 


31 Countries of Europe, Australasia, and other lands 
Registration States of the United States in 1900 . 


1881-1905 
*1890 and 1900 
1856-1905 


154 

153.7 

152.4 







* Census years ending May 31. 



In view of the many material changes in the living habits 
and industrial conditions of the world's population in the last 
generation, the great advance in medical knowledge, and the 
marked decrease in the general death-rate, the practical uni- 
formity of the infantile death-rate the world around is simply 
astounding. On the face of the above showing it apparently 
has a regularity in keeping with that of the American Experi- 
ence Table of mortality; and, bearing in mind the point noted 
in H. Llewellyn Heath's book,— namely, that in the sixteenth 
century the infant deaths constituted 25.9 per cent, of all the 
deaths at Geneva and in 1904 were 25 per cent, of all the deaths 
in England and Wales,— there is an almost weird suggestion of 
the pitiless inflexibility of Fate in the death-rate of infants. 
Of course there are wide variations in the infant death-rates 
of individual communities, but, as the tables herewith presented 
will show, the fluctuations in long-established and stable com- 
munities would seem to be comparatively slight, and, as has 
apparently been demonstrated by the preceding tables, when 
a really broad average has been attained the change in the 
infantile death-rate of the world at large in a long stretch of 
years apparently is almost infinitesimal. 

In most, if not all, countries — and certainly in nearly all 
the States of the United States— there are more or less serious 
defects in the registration of vital statistics, especially in the 
recording of births. That subject has been so thoroughly 



17 

threshed out as to call for no comment here. But, to a certain 
extent, the defects of one country's registration system would 
be offset by the comparative perfection of that in force in some 
other country, in a tabulation of world-wide scope, and in the 
case of the twoscore countries and States dealt with in the last 
table it is not improbable that the percentage of error is sub- 
stantially uniform. Even were the inquiry restricted to the 
two English-speaking sections whose registration systems are 
generally regarded as freest from defects— to wit, England 
and Wales on one side of the Atlantic and the State of Massa- 
chusetts on this side of the water— the variations in their infant 
mortality rates in the last twenty-five years and the averages 
for the entire period differ but slightly, the infant death-rates 
in England and Wales for the five latest five-year periods hav- 
ing been in the order of 139, 145, 151, 156, and 138, and those of 
Massachusetts for the same periods having been 160, 161, 161, 
153, and 138. The widest range of five-year variation in the 
case of England and Wales was 18 per 1,000 births, and that 
in the case of Massachusetts 23 per 1,000 births. Their 
respective averages for the twenty-five year period were 146 
and 154. 

In the tabulation of infant mortality in the principal 
countries of Europe compiled and published in 1890 by Dr. 
Bertillon and reproduced in transposed form on a previous 
page of this paper, the latest date of observation was the year 
1883,— that is to say, twenty-five years ago,— and some of the 
figures dated back to 1862. In those days the registration of 
vital statistics in many— if not most— of the countries of 
Europe was far less advanced than it has become of late years, 
and, taking into account the well-known fact that approximate 
completeness in the registration of deaths almost inevitably 
precedes that of registration of births, it might naturally be 
assumed that the apparent rates of infant deaths to births 
would have been much larger in the case of the records of 
1862-1883 than in those of 1881-1905, the divisor in the pre- 
vious calculation presumably having been much farther re- 
moved from the correct figure. As to how well founded that 



18 



assumption proves, the following comparison of the death- 
rates in the Bertillon table and that compiled by the writer of 
this paper will indicate. 

Some considerable apparent decreases in the infant mortality 
rates of certain countries are to be noted in the following table, 

table v. 

A Comparison op the Infant Mortality in the Principal, Countries op Europe in 
the Last Twenty-five Years with the Earlier Periods Named in Bertillon's 
Table and the Decrease or Increase and Relative Rank in the Case op Each 
of the Countries. 





Infant Mortality 
in Periods Named. 


Deaths 

per 1,000 

Births, 


Decrease 
or 


Rank in Order of 

Lowest Infant 

Mortality. 












Period of 
Observa- 
tion. 


Deaths 

per 1,000 

Births. 


1881- 
1905. 


Increase. 


Early 
Period. 


Later 
Period. 




1865-83 


95.9 


99 


3.1* 


1 


2 




1866-82 


104.9 


94 


10.9 


2 


1 




1865-81 


122.0 


123 


1.0* 


3 


4 




1866-82 


131.9 


104 


27.9 


4 


3 




1870-82 


137.5 


132 


5.5 


5 


5 




1867-83 


148.2 


158 


9.8* 


6 


9 


England and Wales . 


1866-82 


149.2 


146 


3.2 


7 


7 




1878-80 


164.9 


144 


20.9 


8 


6 


France 


1875-82 


166.2 


160 


6.2 


9 


10 


The Netherlands . . 


1878-81 


193.2 


162 


31.2 


10 


11 




1869-80 


195.2 


153 


42.2 


11 


8 




1874-82 


207.8 


202 


5.8 


12 


13 


Italy 


1872-83 


209.7 


175 


34.7 


13 


12 




1875-82 


250.0 


203 


47.0 


14 


14 




1866-83 


255.3 


223 


32.3 


15 


15 


Russia in Europe . . 


1867-78 


266.8 


268 


1.2* 


16 


16 






174.9 


159.1 


15.8 







* Increase. 



and on the face of the returns it would seem that those coun- 
tries were to be congratulated on having somehow succeeded 
in devising ways and means of reducing this phase of the 
mortality problem in which the vast majority of countries have 
notably failed, whether through lack of serious attention to 
the subject or for other reasons. But is such the case? Let 



19 

us go behind the returns, locate the countries which have scored 
the largest apparent decreases, and consider for a moment 
whether those countries might naturally be expected to be 
found in the forefront of the movement for the reduction of 
infant mortality. 

Of the sixteen countries named in the table, eight show an 
apparent annual decrease of more than 10 deaths per 1,000 
births since the early 80's, the decrease ranging from 10.9 in 
the case of Norway up to the remarkable figure of 47 in the 
case of Roumania, and the other countries in the order of the 
largest seeming decrease being Switzerland, Italy, Austria, the 
Netherlands, Sweden, and Finland. And yet none of these 
countries has ever attained any particular prominence in the cru- 
sade for the protection of children's lives. Austria is the only 
one of the eight which could be even seriously considered as 
among the great European powers, and, as will be noted, none 
of the indisputably first-class powers appears in the list. In 
England, France, and Prussia the decrease in the death-rate 
was merely nominal, and, as the registration systems of those 
countries would probably be regarded as superior to that in 
any of the eight countries which have scored the apparent large 
decreases in the infant death-rate, it would seem not only pos- 
sible, but extremely probable, that the decrease in the last-named 
countries was more apparent than real — in other words, was a 
decrease in figures only, very likely due to the material increase 
in the registration of births and the consequent decrease in the 
ratio of deaths under age 1 to births. In England, France, and 
Prussia the registration of births was probably much more 
complete thirty or forty years ago than in most of the smaller 
countries of Europe, and, if such was the case, there naturally 
would be much less fluctuation in the mortality rates in the 
case of those leading countries. Therein probably lies the ex- 
planation of most of the apparent large decreases in the last 
twenty-five years. 

In default of positive evidence it would be absurd to believe 
that the little country of Roumania, with its limited resources, 
had succeeded in effecting a reduction of its infant death-rate 



20 

by nearly 20 per cent, in the last twenty-five years, and thereby 
materially distanced every other country in the world. Further- 
more, as shown in Table III, the record of its infant death- 
rates by five-year periods proves that the rate has been almost 
continuously in the ascendant for that same period. The British 
Registrar-General's office was unable to obtain any infantile 
death-rates from Austria up to 1896, or from Italy up to 1891, 
and in those obtained since those dates there is no sign of any 
sharp decline. Norway, Sweden, Finland, the Netherlands, and 
Switzerland have apparently shown material decreases in the 
infant death-rate in most of the five-year periods of the last 
quarter of a century, but improved registration of births prob- 
ably accounts for that fact in most, if not all, of those cases, 
and it would therefore seem that the pronounced differences 
in some cases between the death-rates of the old-time Bertillon 
table and the up-to-date table presented in connection with 
this study are unworthy of any serious attention. In the face 
of the surprising uniformity of the mortality rate in question 
in the world at large, and especially in countries having 
thoroughly established registration systems, only the most ir- 
refutable evidence will convince any student of infant mor- 
tality of a permanent reduction in the infant death-rate in 
any country up to this time. 

In so far as the infantile death-rate in the United States as 
a whole — either now or at any previous time — is concerned, 
there are absolutely no authentic data. In his contribution to 
the Eleventh Census Report on Vital and Social Statistics, 
published in 1896, Dr. Billings accounted for that fact by au- 
thoritatively stating (Part I, p. 21) that "we have no fully com- 
plete and accurate registration of births in any part of the 
United States. The most accurate registration is probably in 
Massachusetts, in which it is estimated that the deficiency is 
not greater than 2 per cent." Again, in Volume III of the 
Twelfth Census Reports (Vital Statistics, Part I, p. xlix) the 
late William A. King, Chief Statistician for Vital Statistics, 
commenced his discussion of births with the admission that 
"the data relating to births are the most incomplete and unsatis- 



21 



factory of any treated in this report. Were it not considered 
desirable to give such results as bear upon the question for the 
information of students of the statistics, the subject might be 
dismissed with the statement that they are entirely inadequate 
to determine, directly, the general birth-rate of the country, or, 
what is of equal practical importance, the relative birth-rate 
of different classes of population. A number of the States and 
cities have laws requiring the registration of births, but it is 
doubtful if there is a single place in which births are registered 
as fully as deaths." 



DIAGRAM II.— THE INFANT MORTALITY RATES OF ENGLAND AND WALES, 
PRUSSIA, FRANCE, AND THE STATE OF MASSACHUSETTS BY FIVE-YEAR 
PERIODS FROM 1881 TO 1905, ON THE BASIS OF DEATHS UNDER 1 YEAR 
PER 1,000 BIRTHS, STILL-BIRTHS EXCLUDED. 



I 

<no 
oo© 
oo co 



I 

COO 

coo 

GCO! 



210 up 
Deaths per 1 ,000 Birth? i§ 
Prussia 

200 



190 
180 

170 
France 

Massachusetts . 160 
150 



140 
England and Wales 



130 
Prussia; 




France; 



I Massachusetts ; 



England and Wales. 



22 

As the census authorities have repeatedly stated, the data 
regarding the number of living children under 1 year of age are 
also utterly incomplete and inaccurate, owing to the fact that 
the number so returned is too small in practically all localities, 
partly owing to the practically universal tendency to report 
children in the later months of the first year as 1 year old. For 
these reasons it would be utterly futile to attempt the com- 
pilation of any figures of the infant mortality rate in the United 
States at large for purposes of comparison with the returns for 
other countries presented in the preceding tables. In the Regis- 
trar-General's annual reports for some years past, returns of 
this character from thirty-two countries have been presented, 
but the United States has been the one great country in the 
world for which no figures were given. 

In the light of these conditions it might at first seem practi- 
cally impossible to obtain even an approximate idea of the status 
of infant mortality in this country, but such is not the case, the 
number of registration States and the magnitude of their com- 
bined population being sufficient to afford a fairly accurate index 
of the conditions in Continental United States as a whole. The 
registration systems of these States greatly differ in point of 
comprehensiveness and reliability, but by common consent 
that of Massachusetts is regarded as of foremost importance, 
and the complete record of infant deaths in that State for the 
last half-century undoubtedly affords by far the best available 
standard of measurement and comparison in a study of infant 
mortality in this country. In the Twenty-eighth Annual Re- 
port of the State Board of Health of Massachusetts, published 
in 1897, there appeared a comprehensive study of "The Vital 
Statistics of Massachusetts — A Forty Years' Summary," which 
was prepared by Dr. Samuel W. Abbott, secretary of the 
Board of Health. This chapter of more than 100 pages (pp. 
711-829) begins with a graphic tracing of the "Marriage, Birth, 
and Death Rates and Infantile Death-rate, Massachusetts, 40 
Years, 1856-95," and contains a complete tabulation of "Infant 
Mortality, Massachusetts, 1856-95, Forty Years," presenting 
the annual figures for each of those years. 



23 

For some reason not explained in the text, the birth statis- 
tics in that tabulation begin with July 1, 1856, and end with 
June 30, 1895, whereas the deaths under 1 year in the same 
table are taken from the calendar-year records, thus making 
the birth and death rate figures materially differ from those in 
the twenty-year infant mortality record presented in recent 
Massachusetts registration reports of births, marriages, and 
deaths. It has seemed desirable to eliminate this discrepancy, 
and the following tabulation of infant mortality in Massachusetts 
for the fifty years ending Dec. 31, 1905, has therefore been 
compiled in part from Dr. Abbott's table of infant mortality 
(p. 750), in so far as deaths under 1 from 1856 to 1895, inclusive, 
are concerned, and partly from his tabulation of marriages, 
births, and deaths from 1842 to 1895 (pp. 721-722), the supple- 
mental figures for births and infant deaths in the calendar years 
1896 to 1905, inclusive, being taken from the twenty-year table 
of infant mortality in the current (sixty-fifth) Massachusetts 
Report of Births, Marriages, and Deaths (p. 205). The com- 
posite tabulation of infant mortality herewith presented is thus 
made complete for the fifty calendar years ending with 1905, 
and, in order to permit of comparison with the statistics of 
foreign countries presented in the previous tables accompanying 
this article, is supplemented with a column containing the annual 
birth-rates in Massachusetts for the last fifty calendar years, as 
presented in the Sixty-fifth Massachusetts Report of Births, Mar- 
riages, and Deaths (pp. 141-142). Still-births have been ex- 
cluded in all cases. 



TABLE VI. 

A Complete Record of Births, Deaths under Age 1, the Infantile Death-rate 
per 1,000 Births, and the Birth-rate in Massachusetts for Each of the Fifty 
Years 1856-1905, Inclusive, excluding Still-births. 







Deaths under 1 Year. 






Births. 




Birth-rate 


Calendar Year. 






per 1,000 






Number. 


Rate per 
1,000 Births. 


Population. 


1856 


34,445 


4,226 


122.7 


29.91 


1857 


35,320 


4,160 


117.8 


30.17 


1858 


34,491 


4,197 


121.7 


28.97 


1859 


35,422 


4,175 


117.9 


29.28 


1860 


36,051 


4,821 


133.7 


29.28 


1861 


35.445 


5,167 


145.8 


28.63 


1862 


32,275 


4,216 


130.6 


25.92 


1863 


30,314 


4,545 


149.9 


24.20 


1864 


30,449 


4,693 


154.1 


24.17 


1865 


30,249 


4,869 


161.0 


23.87 


1866 


34,085 


4,699 


137.9 


26.16 


1867 


35,062 


4,763 


135.8 


26.17 


1868 


36,193 


5,421 


149.8 


26.26 


1869 


36,141 


5,368 


148.5 


25.50 


1870 


38,259 


6.206 


162.2 


26.25 


1871 


39,791 


5,996 


150.7 


26.63 


1872 


43,235 


8,390 


194.1 


28.21 


1873 


44,481 


7,911 


177.8 


28.31 


1874 


45,631 


7,489 


164.1 


28.32 


1875 


43,996 


7,712 


175.3 


26.63 


1876 


42,149 


6,700 


159.0 


25.12 


1877 


41,850 


6,343 


151.5 


24.57 


1878 


41,238 


6,189 


150.1 


23.85 


1879 


40,295 


5,855 


145.3 


22.95 


1880 


44,217 


7,190 


162.6 


24.80 


1881 


45,220 


7,389 


163.4 


24.93 


1882 


45,670 


7,445 


163.0 


24.75 


1883 


47,285 


7,515 


158.9 


25.14 


1884 


48,615 


7,735 


159.1 


25.46 


1885 


48,790 


7,625 


156.3 


25.12 


1886 


50,788 


7,848 


154.5 


25.42 


1887 


53,174 


8,514 


160.1 


25.86 


1888 


54,893 


8,870 


161.6 


25.95 


1889 


57,075 


9,105 


159.5 


26.23 


1890 


57,777 


9,625 


166.6 


25.81 


1891 


63,004 


10,186 


161.7 


27.53 


1892 


65,824 


10,649 


161.7 


28.13 


1893 


67,192 


10,990 


163.6 


28.09 


1894 


66,936 


10,899 


162.8 


27.37 


1895 


67,545 


10,564 


156.4 


27.02 


1896 


72,343 


11,765 


157.8 


28.27 


1897 


73,205 


10,751 


146.9 


27.96 


1898 


73,110 


11,012 


150.6 


27.29 


1899 


70,457 


10,532 


149.5 


25.70 


1900 


73,386 


11,500 


156.7 


26.16 


1901 


71,976 


9,952 


138.3 


25.07 


1902 


72,219 


10,075 


139.5 


24.58 


1903 


73,584 


10,269 


138.3 


24.48 


1904 


75,014 


9,992 


133.2 


24.39 


1905 


75,022 


10,519 


140.2 


24.98 


Totals 


2,511,188 


382,627 


152.4 


26.32 



25 



Thanks to the early establishment of the registration system 
of Massachusetts, recognized the world over for many years as 
the most reliable index of American vital statistics, the preced- 
ing table unquestionably affords by far the most comprehensive 
and most authoritative tracing of infant mortality in at least 
one section of this country which is now obtainable from any 
or all sources. The pronounced annual fluctuations in both 
birth and death rates are somewhat misleading, however, and 
the appended tabulation of births and infant deaths by five-year 
periods not only puts the case much more comprehensibly, but 
also reduces the Massachusetts tabulation to the basis followed 
in the preceding foreign tabulations, and thus makes possible a 
comparison by five-year periods. Thus arranged, the state- 
ment of births and infant deaths in Massachusetts for the last 
half-century is as follows : — 

TABLE VII. 

Births, Birth-rates per 1,000 Population, and Deaths under 1 Year and their 
Rate per 1,000 Births in Massachusetts by Five-tear Periods for the Fifty 
Years 1856-1905, Inclusive — Still-births excluded in Both Cases. 





Living Births. 


Deaths under 1 Year. 


Five-Year Periods. 


Number. 


Birth-rate 

per 1,000 

Population. 


Number. 


Rate per 
1,000 Births. 


1856-60 

1861-65 

1866-70 

1871-75 

1876-80 

1881-85 

1886-90 

1891-95 

1896-1900 

1901-05 


175,729 
158,732 
179,740 
217,134 
209,749 
235,580 
273,707 
330,501 
362,501 
367,815 


29.52 
25.36 
26.07 
27.62 
24.26 
25.09 
25.85 
27.63 
27.08 
24.70 


21,579 
23,490 
26,457 
37,498 
32,277 
37,709 
43,962 
53,288 
55,560 
50,807 


122.8 
148.0 
147.2 
172.7 
153.9 
160.1 
160.6 
161.2 
153.3 
138.1 


Totals 


2,511,188 


26.32 


382,627 


152.4 



Recapitulation by Twenty-five Year Periods. 



1856-1880 
1881-1905 



941,084 
1,570,104 



26.57 
26.07 



141,301 
241,326 



150.1 
153.7 



26 



When the summary for the last twenty-five years, in the last 
line of this table, is compared with the corresponding figures 
for foreign countries presented in Table III of this paper, one is 
immediately impressed with the surprising uniformity of the 
infant mortality rate the world around, which has already been 
alluded to. In the thirty-one foreign countries, in widely re- 
mote parts of the world, dealt with in Table III, the general 
average of deaths under 1 year to each 1,000 births in the 
twenty-five years ending with 1905 was 154 : in the same period 
the infant death-rate in Massachusetts was 153.7. In the 
twenty European countries whose returns are presented in 
Table III — Austria, Hungary, and Russia, with their abnormally 
high death-rates, included — the average infant death-rate for 
the last twenty-five year period was 162 as compared with the 
Massachusetts rate of 153.7, and for the five five-year periods 
involved the European infant death-rates were, in order, 163, 
162, 169, 162, and 153, as compared with death-rates of 160.1, 
160.6, 161.2, 153.3, and 138.1 in Massachusetts. In fact, the 
correspondence between the infant death-rates of Europe and 
its leading countries and those of Massachusetts is so strik- 
ingly close that it can only be appreciated by means of a tabu- 
lar statement, such, for instance, as the following : — 

TABLE VIII. 



A Comparison of the Infant Mortality Rates per 1,000 Births of the World at 
Large and Leading European Countries with those of Massachusetts by 
Five-year Periods, 1881-1905, Inclusive. 





1881 

to 
1885. 


1886 

to 
1890. 


1891 

to 
1895. 


1896 

to 
1900. 


1901 

to 

1905. 


1881 

to 
1905. 


31 foreign countries in all parts of the world . . . 


155 
163 
171 
153 


152 
162 
173 
156 


159 
169 
176 
161 


157 
162 
172 
158 


147 
153 
156 
139 


154 
162 




169 
153 




160 


161 


161 


153 


138 


154 







27 

This table tells its own story, and would seem to prove beyond 
all peradventure that there is a general uniformity in the un- 
dulations of the infant mortality wave at various periods, in 
the world at large, however mysterious and inexplicable may 
be the undiscovered influences which regulate it. As will be 
observed, in all the different groups of countries above presented, 
there was a gradual rise in the death-rate up to 1891-95, and a 
gradual falling from 1895 to 1905, in each case the top notch 
being arrived at in 1891-5, and in every case except that of 
Massachusetts the death-rate for the entire twenty-five year 
period being practically identical with that of the first five-year 
period. The Massachusetts rate for the twenty-five years was 
lower by 6 deaths per 1,000 births than was the rate for the 
first five years, whereas in the case of all the other sections of 
the world named the largest decrease in the twenty-five year 
average as compared with the rate for the first five years was 
only 2 deaths per 1,000 births; and the comparison of the Massa- 
chusetts figures with those for England and Wales, France, and 
Prussia, is a particularly reliable one for the reason that the 
registration systems of those sections are presumably freer from 
error than any others which could be selected. 

In short, this latest tabulation strongly confirms the broad 
average showings of Table III, and again suggests the question 
before raised— namely, why this surprising uniformity in the 
infant death-rate the world around? Furthermore, why the 
general rise in the death-rate from 1881 to 1895, and why the 
general fall in the death-rate from the last-named date down to 
1905? No living man can rationally answer those grave ques- 
tions. It would be pleasant to believe that, as the world ad- 
vances in knowledge, in hygiene and sanitation, and in humani- 
tarianism, infant mortality correspondingly decreases; but only 
a substantially continuous decline in the infant death-rate 
for a long term of years, in countries with thoroughly estab- 
lished registration systems, could substantiate any such opti- 
mistic theory. 

As previously stated, the fifty-year record of Massachusetts 
affords the very best available standard of measurement and 



28 



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29 

comparison for any study of infant mortality in this country, 
and in comparison with that standard the reports of recent 
decennial censuses of the United States, at best dealing with 
single twelvemonths ten years apart, are of but little value. 
In his interesting paper issued under the title of "A Discussion 
of the Vital Statistics of the Twelfth Census" by the Bureau 
of the Census in 1904 (Bulletin 15), Dr. Billings thus clearly 
explains this fact (pp. 7-8): "If the purpose in consulting 
these reports be to obtain comparative data showing the 
result of varying conditions upon the general mortality, or to 
show the relative death-rates at different ages, from different 
causes or of different classes of population in the same or differ- 
ent places during a series of consecutive years, the informa- 
tion must be sought from the local reports on this subject 
issued by the States or cities for which comparisons are wanted. 
Here the student or analyst finds great difficulty in securing 
any comprehensive information, owing to lack of tables cover- 
ing the details sought. Very few of the cities make any exten- 
sive compilation of the material at their command, and in such 
compilations which are most complete, as well as in the State 
reports, there are differences in the forms of tables and in the 
methods of classifying the data which prevent carrying com- 
parisons very far, even if they do not entirely preclude them. 
... No State has a complete registration of births, the ones 
that come nearest to it being probably Massachusetts, Rhode 
Island, and Connecticut, but the results of the registration 
in these States should be sought, not in the census report, but 
in the State reports of births, marriages, and deaths. The 
only States which had (at the time the Twelfth Census was 
taken) a registration of deaths sufficiently complete to make 
the death-rates worth calculating were Connecticut, Maine, 
Massachusetts, Michigan, New Hampshire, New Jersey, New 
York, and Rhode Island, which with the District of Columbia 
(and Vermont) form the group referred to in the census report 
as the 'registration' States." 

Having secured by the courtesy of the registration officials 
of all the registration States copies of their recent reports, and 



30 

carefully studied them with a view to the compilation, if pos- 
sible, of a general resume of the infant death-rates in those 
States for a period of sufficient length to warrant at least cer- 
tain general deductions, the writer is more than ready to agree 
with Dr. Billings that "in the State reports [of vital statistics] 
there are differences in the forms of tables and in the methods 
of classifying the data which prevent carrying comparisons 
very far, even if they do not entirely preclude them." 

The Massachusetts report affords by far the best data for 
that purpose, containing a compact tabulation of infant mor- 
tality and the rate per 100 living births for each of the last 
twenty years. But no such thoroughly welcome data are to 
be found in any of the other registration States' current re- 
ports. The Connecticut report, which probably ranks second 
in general utility, has a ten-year table of mortality and death- 
rates by ages, but the death-rates for children under 1 year 
are the percentage ratios to total mortality. The New Jersey 
report's data and diagram dealing with infant mortality are 
made up on a basis of deaths under 5 years. The Rhode 
Island report states the annual infant death-rates to births 
for the last five years, but presents the rates for the previous 
fifty years in the abbreviated form of three ten-year and one 
twenty-year ratios. Most, if not all, of the other registration 
reports are even less serviceable in any extended compilation 
of infant mortality, in some cases still-births having been in- 
cluded in the figures up to very recent dates ; and after a study 
of them all it became apparent that the United States census 
reports afford the only practicable means of securing within 
any reasonable time a comparative showing of the infant mor- 
tality in even the registration States for any considerable 
stretch of time, that is to say, with all the figures compiled 
and tabulated on a common basis. For reasons already stated 
an attempt to tabulate the returns from the country at large, 
including the non-registration States, would have been un- 
worthy of serious consideration. 

In the introductory remarks to his analysis of the vital sta- 



31 

tistics of the Twelfth Census, the late William A. King noted 
(vol. iii, p. xii) that "the census utilization of registration 
records as a source of information commenced with the Tenth 
Census (1880), when copies of the records of two States, Mas- 
sachusetts and New Jersey, were secured and used as the basis 
of the statistics for those States. At the Eleventh Census 
(1890) the registration area was extended to include seven 
other States, namely: Connecticut, Rhode Island, New Hamp- 
shire, Vermont, New York, Delaware, and the District of Co- 
lumbia, with the cities therein and 83 cities in other States." 
As stated in the introduction to the inaugural volume of the 
present annual mortality statistics, issued in 1906 by the 
Bureau of the Census (p. xiv), when the Twelfth Census was 
taken the registration area included all of the last-named 
States, and in addition the States of Maine and Michigan, and 
153 cities of 8,000 or more population in other States. 

The census utilization of registration records not having 
commenced until the taking of the Tenth Census, in 1880, 
any inquiry regarding infant mortality in this country as 
recorded in the census reports is obviously restricted to the 
Tenth Census for the earliest records of any value whatsoever, 
and the tables which have been prepared for this paper are 
therefore confined to the records of the Tenth, Eleventh, and 
Twelfth Censuses. Although Massachusetts and New Jersey 
were the only States whose registration records were used in 
the compilation of the Tenth Census, most, if not all, of the 
other registration States of 1900 had established bureaus of 
vital statistics as early as 1880. All of them except Maine and 
Michigan were included among the registration States when 
the Eleventh Census was taken, and, in order to make the com- 
parison complete for the three latest censuses, the figures for 
both 1880 and 1890 of all the registration States of 1900 
are included in the following tables. Prior to the Twelfth 
Census, still-births, which were then excluded, had been in- 
cluded in the United States census mortality figures, but in all 
of the tables here presented the still-births for all three census 
years have been eliminated. 



32 



In the second annual report of the Registrar-General's office, 
issued in 1840, in his discussion of the mortality of children, 
Dr. Farr laid down the rule (p. 16) that, "even though the 
registration of births is still deficient, yet, even with this ad- 
mitted probable deficiency, the number of births, if applied as 
an element of calculation, will show a mortality much less than 
it appears in the Comparative Table of Deaths," and from that 
day to this that method of calculating the infant mortality rate 
has practically been regarded by all statistical authorities on the 
subject as freest from error, and hence the most reliable of all 
known methods of measuring the rate. By applying this stand- 
ard of measurement the deaths under 1 year and rates per 1,000 
births in 1880, 1890, and 1900 in the registration States of 1900, 
have been as shown in the appended table, according to the 
United States census reports for the years in question. 

Many and serious as the defects in this table are — especially 
for the earliest year, 1880, when Massachusetts and New Jersey 
were the only registration States — it probably provides at 



TABLE IX. 

Births, Deaths under 1, and Death-rates per 1,000 Births in Each of the Registration States 

op 1900, according to the tenth, eleventh, and twelfth census reports still-births 

excluded in Each Case. 





Census Year 1900. 


Census Year 1890. 


Census Year 1880. 


States. 


Births 
during 
Census 
Year. 


Deaths 
under 
1 Year 
of Age. 


Deaths 

under 1 

per 

1,000 

Births. 


Births 
during 
Census 
Year. 


Deaths 
under 
1 Year 
of Age. 


Deaths 

under 1 

per 

1,000 

Births. 


Births 
during 
Census 
Year. 


Deaths 
under 
1 Year 
of Age. 


Deaths 

under 1 

per 

1,000 

Births. 


Registration States of 
1900 


418,321 


60,524 


144.7 


329,823 


53,645 


162.6 


297,490 


36,036 


121.1 


District of Columbia . 
Massachusetts .... 
New Hampshire . . . 

Rhode Island .... 


21,757 

5,612 

14,716 

67,228 

58,800 

8,872 

48,158 

175,334 

10,472 

7,372 


3,101 
1,306 
1,946 

10,754 
6,570 
1,384 
7,292 

25,492 

1,854 

825 


142.5 
232.7 
132.2 
160.0 
111.7 
156.0 
151.4 
145.4 
177.0 
111.9 


15,864 

5,314 

11,761 

48,156 

51,931 

6,918 

36,351 

139,642 

7,732 

6,154 


2,344 
1,382 
1,124 
8,792 
4,667 
1,063 
6,939 
25,208 
1,490 
636 


147.8 
260.1 

95.6 
182.6 

89.9 
153.7 
190.9 
180.5 
192.7 
103.3 


13,825 

* 5,454 

13,447 

41,338 

45,244 

6,557 

31,069 

126,740 

6,603 

7,213 


1,387 
* 1,283 

912 
5,891 
3,744 

589 

4,296 

16,632 

711 

591 


100.3 
* 235.2 

67.8 
142.5 

82.7 

89.8 
138.3 
131.2 
107.7 

81.9 



* Including still-births, no returns for still-births being given in reports of Tenth Census. 



33 

least an approximate idea of the relative death-rates among 
children under 1 year of age in the States in question in the 
census years 1880, 1890, and 1900. The District of Columbia 
has been included solely for the reason that it was part and 
parcel of the registration area in 1900, but its death-rate is not 
to be seriously considered, including as it does the heavy mortal- 
ity among colored children, the colored infant death-rate being 
nearly twice as high as the white rate in each case. As the 
District of Columbia was the only portion of the registration 
area in 1900 having any considerable percentage of colored 
population, and as the comparatively unimportant colored mor- 
tality in the registration States is a negligible quantity so far 
as affecting the general mortality rates is concerned, it was not 
deemed advisable to attempt to separate the white and colored 
mortality in the preparation of the tables in this paper based 
upon the census reports. The District of Columbia figures 
are, therefore, of practically no importance in this analysis of 
the statistics of infant mortality, and may properly be disre- 
garded in the study of any of the tables in which they appear. 
With them eliminated, it will be noted that in 1880 Massachu- 
setts apparently led all the States named in its apparent infant 
death-rate of 142.5, but that Rhode Island took the lead in 1890 
and retained it in 1900. According to the census reports, 
Massachusetts' infant death-rates in the census years 1880, 
1890, and 1900, were respectively 142.5, 182.6, and 160.0 as 
compared with rates of 162.6, 166.6, and 156.7 for the calendar 
years in question, according to the registration records of the 
State as presented in Table VI. 

The above table undoubtedly presents the most accurate 
showing of infant mortality in the districts dealt with which 
can be compiled from the census reports for the years in ques- 
tion, but, in order to perfect the statistical record of the subject, 
it may be worth while to find space for the infant death-rates in 
the several States named, as measured, (1) by the rate of deaths 
under 1 year per 1,000 of the supposed living population of 
that age, and (2) by the ratio of infant deaths to total deaths. 
The census figures in both cases are presented in Tables X and 
XI herewith appended : — 



TABLE X. 

The Infant Mortality Rate in 1880, 1890, and 1900 in Each of the Registration States of 1900, 
as Measured by the Rate of Deaths under 1 Year per 1,000 Living Population of that Age, 
according to the tenth, eleventh, and twelfth census report still-births excluded. 





Census Year 1900. 


Census Year 1890. 


Census Year 1880. 


States. 


Popula- 
tion at 
End of 
Census 
Year. 


Deaths. 


Death- 
rate 
per 
1,000 
Living. 


Popula- 
tion at 
End of 
Census 
Year. 


Deaths. 


Death- 
rate 
per 
1,000 

Living. 


Popula- 
tion at 
End of 

Census 
Year. 


Deaths. 


Death- 
rate 
per 
1,000 
Living. 


Registration States of 


379,951 


60,524 


159.3 


298,154 


53,645 


179.9 


273,559 


36,036 


131.7 




19,774 


3,101 


156.8 


14,469 


2,344 


162.0 


12,879 


1,387 


107.7 


District of Columbia . 


4,758 


1,306 


274.5 


4,467 


1,382 


309.4 


4,624 


*1,283 


*277.5 




13,503 


1,946 


144.1 


11,158 


1,124 


100.7 


12,812 


912 


71.2 


Massachusetts .... 


60,492 


10,754 


177.8 


43,043 


8,792 


204.3 


37,587 


5,891 


156.7 




54,161 


6,570 


121.3 


48,954 


4,667 


95.3 


42,585 


3,744 


87.9 


New Hampshire . . . 


8,048 


1,384 


172.0 


6,347 


1,063 


167.5 


6,141 


589 


95.9 




43,571 


7,292 


167.3 


32,087 


6,939 


216.2 


28,192 


4,296 


152.4 




159,521 


25,492 


159.8 


124,977 


25,208 


201.7 


115,847 


16,632 


143.6 


Rhode Island .... 


9,368 


1,854 


197.9 


6,890 


1,490 


216.3 


6,132 


711 


115.9 




6,755 


825 


122.1 


5,762 


636 


110.4 


6,760 


591 


87.4 



* Including still-births, no returns for still-births being given in reports of Tenth Census. 



TABLE XI. 

The Infant Mortality Rate in 1880, 1890, and 1900 in Each of the Registration States of 1900, 
as Measured by the Rate of Deaths under 1 Year per 1,000 Deaths at All Ages, according 
to the Tenth, Eleventh, and Twelfth Census Reports — Still-births excluded. 





Census Year 1900. 


Census Year 1890. 


Census Year 1880. 


States. 


Total 
Deaths 
during 
Census 

Year. 


Deaths under 
Age 1 during 
Census Year. 


Total 
Deaths 
during 
Census 

Year. 


Deaths under 
Age 1 during 
Census Year. 


Total 
Deaths 
during 
Census 

Year. 


Deaths under 
Age 1 during 
Census Year. 




Deaths. 


Rate 
per 
1,000 
at All 
Ages. 


Deaths. 


Rate 
per 
1,000 
at All 
Ages. 


Deaths. 


Rate 
per 
1,000 
at All 
Ages. 


Registration States of 
1900 


301,670 


60,524 


200.6 


262,149 


53,645 


204.6 


191,230 


36,036 


188.4 




15,422 


3,101 


201.1 


13,863 


2,344 


169.1 


8,977 


1,387 


154.5 


District of Columbia . 


6,364 


1,306 


205.2 


5,449 


1,382 


253.6 


*4,192 


*1,283 


*306.1 




12,148 


1,946 


160.2 


9,974 


1,124 


112.7 


9,384 


912 


97.2 


Massachusetts .... 


49,756 


10,754 


216.1 


43,102 


8,792 


204.0 


31,752 


5,891 


185.5 




33,572 


6,570 


195.7 


24,118 


4,667 


193.5 


19,144 


3,744 


195.6 


New Hampshire . . . 


7,400 


1,384 


187.0 


6,856 


1,063 


155.0 


5,503 


589 


107.0 




32,735 


7,292 


222.7 


28,455 


6,939 


243.8 


18,434 


4,296 


233.0 




130,268 '25,492 


195.7 


117,837 


25,208 


213.9 


84,450 


16,632 


196.9 


Rhode Island .... 


8,176 j 1,854 


226.8 


7,234 


1,490 


206.0 


4,507 


711 


157.7 




5,829 ■ 825 


141.5 


5,261 


636 


120.9 


4,887 


591 


120.9 



* Including still-births, no returns for still-births being given in reports of Tenth Census. 



35 

Were the tabulation of the census records of the infant death- 
rate per 1,000 of living population under 1 year at the end of 
each census year unaccompanied by tables based on other stand- 
ards of measuring infant mortality, affording ready means of 
checking the various figures and thus measuring the probable 
margin of error, it would be comparatively valueless. For, as 
previously stated, the census authorities have often admitted 
that the data regarding the number of living children under 1 
year of age are utterly incomplete and inaccurate. As Dr. 
Farr put it in discussing the mortality of infants (Supplement 
to 25th Annual Report of the Registrar-General, pp. v-vi), "The 
infants in the first year of life are to some extent mixed up with 
infants in the second year of age." And, as Dr. Billings ex- 
plained in his remarks regarding infantile mortality published 
in the Report on Vital and Social Statistics in the United States 
at the Eleventh Census (Part I, p. 21): "Unfortunately, these 
data are incomplete and inaccurate, not only for the United 
States as a whole, but for all parts of the registration area. This 
is due to the fact that the number of children returned as being 
under 1 year of age is too small in every locality, owing partly 
to omissions in the enumeration, and partly to the tendency of 
those reporting the age of infants to report those who are be- 
tween 9 and 12 months of age as being, in round numbers, 1 
year old, which last is a defect common to the censuses of all 
countries." 

The apparent living population under 1 year of age for these 
reasons being much understated in the returns, of course the 
alleged rates of deaths under 1 to the living population at that 
age are almost invariably in excess of the actual rates on that 
basis: hence the table worked out on those lines would be of 
little value by itself. The tabulation of rates of infant deaths 
per 1,000 deaths at all ages probably is open to less objection, 
but that table, too, is open to much more intelligent interpre- 
tation when supplemented with tables prepared on other bases 
of measurement, and especially with one laid out on the gener- 
ally accepted plan of death-rates to births. But for the presence 
of the last-named table, it would not have been considered 



36 

worth while to present in this article the two other tables above 
mentioned. 

The death-rate of persons over 1 year of age is a natural com- 
plement to the death-rate of infants under 1 year, if both are 
prepared on a common basis, and materially aids in deter- 
mining whether a high infant mortality is presumably, in part 
at least, due to unsanitary conditions or to independent causes. 
In none of the works on the subject of infantile mortality which 
the writer has examined does such a tabulation appear, and by 
way of adding at least some information to the statistical rec- 
ords of the subject the following table has been prepared, on 
the basis of the census reports for 1880, 1890, and 1900: — 

TABLE XII. 

Deaths over 1 Year op Age and Rate per 1,000 Population over 1 Year in 1880, 1890, and 1900 
in the Registration States of 1900, according to the Tenth, Eleventh, and Twelfth Census 
Reports. 







Census Year 1900. 


Census Year 1890. 


Census Year 1880. 


States. 


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Registration States 
of 1900 .... 


17,064,329 


241,146 


14.1 


14,169,658 


208,504 


14.7 


11,765,518 


155,194 


13.2 


Connecticut . . . 
District of Columbia, 
Maine 


888,646 

273,960 

680,963 

2,744,854 

2,366,821 

403,540 

1,840,098 

7,109,373 

419,188 

336,886 


12,321 

5,058 

10,202 

39,002 

27,002 

6,016 

25,443 

104,776 

6,322 

5,004 


13.9 
18.5 
15.0 
14.2 
11.4 
14.9 
13.8 
14.7 
15.1 
14.9 


731,789 

225,925 

649,928 

2,195,900 

2,044,935 

370,183 

1,412,846 

5,872,876 

338,616 

326,660 


11,519 

4,067 

8,850 

34,310 

19,451 

5,793 

21,516 

92,629 

5,744 

4,625 


15.7 
18.0 
13.6 
15.6 
9.5 
15.6 
15.2 
15.8 
17.0 
14.2 


609,821 

173,000 

636,124 

1,745,498 

1,594,352 

340,850 

1,102,924 

4,967,024 

270,399 

325,526 


7,590 

2,909 

8,472 

25,861 

15,400 

4,914 

14,138 

67,818 

3,796 

4,296 


12.4 
16.8 
13 3 


Massachusetts 
Michigan .... 




14.8 
9 7 


New Hampshire 
New Jersey . . . 
New York . . . 
Rhode Island . . 
Vermont . . . 


14.4 
12.8 
13.7 
14.0 
13.2 



37 

In so far as the mortality reports of the Tenth, Eleventh, 
and Twelfth Censuses contribute any really material data to the 
records of infant mortality in the last three census years in the 
States recognized as registration States in 1900, the preceding 
table practically rounds out the information therein obtainable, 
and it might now seem to be in order to make a comparison of 
the infant death-rates in the several registration States as 
measured by the standards of the various tables which have 
been presented. By so doing, at least an approximate idea of 
the actual relative rank of the States in question in point of 
their respective infant death-rates may be obtained, and, pos- 
sibly, some information of working value be contributed to 
the rapidly growing bibliography of the subject. Perhaps the 
shortest and most effective means of reaching this end will be 
that of assembling at close contact the infant death-rates of each 
State according to the various standards of calculation em- 
ployed in the preceding tables, and attaching in each case the 
numeral showing the relative rank of the State in question 
from that point of view. In compact form here are the results 
of an inquiry shaped on those lines, eliminating the District of 
Columbia for reasons previously explained: — 



TABLE XIII. 

A Comparison op the Infant Mortality Rates— and Their Complement, the Death-rate at All 
Ages over 1 Year— in 1900, 1890, and 1880 in the Registration States op 1900, and the Rela- 
tive Rank op Each op the Nine States in the Order op Those Death-rates. 





Death-rate under 1 Yeai 


per 1,000 


Death-rate under 1 Year per 1,000 of 






Births. 






that Age living at End of Census Year. 


States. 


1900. 


1890. 


1880. 


1900. 


1890. 


1880. 




Rate. 


Rank. 


Rate. 


Rank. 


Rate. 


Rank. 


Rate. 


Rank. 


Rate. 


Rank. 


Rate. 


Rank. 


Connecticut . . . 


142.5 


6 


147.8 


6 


100.3 


5 


156.8 


6 


162.0 


6 


107.7 


5 


Maine 


132.2 


7 


95.6 


8 


67.8 


9 


144.1 


7 


100.7 


8 


71.2 


9 


Massachusetts . . 


160.0 


2 


182.6 


3 


142.5 


1 


177.8 


2 


204.3 


3 


156.7 


1 


Michigan .... 


111.7 


9 


89.9 


9 


82.7 


7 


121.3 


9 


95.3 


9 


87.9 


7 


New Hampshire . 


156.0 


3 


153.7 


5 


89.8 


6 


172.0 


3 


167.5 


5 


95.9 


6 


New Jersey . . . 


151.4 


4 


190.9 


2 


138.3 


2 


167.3 


4 


216.2 


2 


152.4 


2 


New York .... 


145.4 


5 


180.5 


4 


131.2 


3 


159.8 


5 


201.7 


4 


143.6 


3 


Rhode Island . . 


177.0 


1 


192.7 


1 


107.7 


4 


197.9 


1 


216.3 


1 


115.9 


4 


Vermont .... 


111.9 


8 


103.3 


7 


81.9 


8 


122.1 


8 


110.4 


7 


87.4 


8 



38 



TABLE XIII— Continued. 





Death-rate under 1 Year per 1,000 


Death-rate for All Ages over 1 Year per 1 ,000 






Deaths at All Ages. 




of Those Ages 


Living at End of Census Year. 


States. 


1900. 


1890. 


1880. 


1900. 


1890. 


1880. 




Rate. 


Rank. 


Rate. 


Rank. 


Rate. 


Rank. 


Rate. 


Rank. 


Rate. 


Rank. 


Rate. 


Rank. 


Connecticut . . . 


201.1 


4 


169.1 


6 


154.5 


6 


13.9 


7 


15.7 


3 


12.4 


8 




160.2 


8 


112.7 


9 


97.2 


9 


15.0 


2 


13.6 


8 


13.3 


5 


Massachusetts . . 


216.1 


3 


204.0 


4 


185.5 


4 


14.2 


6 


15.6 


4— 


14.8 


1 


Michigan .... 


195.7 


5— 


193.5 


5 


195.6 


3 


11.4 


9 


9.5 


9 


9.7 


9 


New Hampshire . 


187.0 


7 


155.0 


7 


107.0 


8 


14.9 


3— 


15.6 


4— 


14.4 


2 


New Jersey . . . 


222.7 


2 


243.8 


1 


233.0 


1 


13.8 


8 


15.2 


6 


12.8 


7 


New York . . . 


195.7 


5— 


213.9 


2 


196.9 


2 


14.7 


5 


15.8 


2 


13.7 


4 


Rhode Island . . 


226.8 


1 


206.0 


3 


157.7 


5 


15.1 


1 


17.0 


1 


14.0 


3 


Vermont .... 


141.5 


9 


120.9 


8 


120.9 


7 


14.9 


3— 


14.2 


7 


13.2 


6 



A somewhat noticeable feature of this tabulation of compari- 
sons is the fact that, materially differing though the infant 
death-rates of any particular State do in any one census year 
as measured by the ratios to births and to living population at 
the age of 1 at the end of the census year, in every case the 
relative rank of the State as determined by the two standards 
remains the same in all three census years. For instance, 
Massachusetts ranked first in 1880, third in 1890, and second 
in 1900 in point of both death-rates to births and to living 
population under age 1 at the end of the census year; New 
Jersey ranked second in both 1880 and 1890, and fourth in 
1900, by both measurements, and so on. In a general way, it 
might be expected that there probably would be no radical 
shift in the ranking of the States from census to census in point 
of either the number of births or the population under age 1 
at the end of the census years, but the coincidence of each 
State's ranking remaining the same in any census year, whether 
measured by the rate of infant deaths to births or to surviving 
infants under age 1 at the end of the census year, is at least 
passing strange, taking into account the habitual and historic 
inaccuracy in the reporting of living infants under age 1. 

Of course, if the infant migration and emigration in a census 



39 

year were disregarded, if the infant deaths during the census 
year were restricted to babies born during the year, and if 
census returns were complete and absolutely accurate, the 
number living under age 1 at the end of the year would be the 
exact complement of the number dying during the year. But the 
infant migration and emigration cannot be disregarded. A 
minor but considerable percentage of the infant deaths in any 
year are those of babies born in the later months of the previous 
year; and the returns for births, deaths, and living population 
by ages — especially for population under age 1 — are, and 
always have been, notoriously incomplete and inaccurate. 
Hence the absolute uniformity of the ranking of each State 
in the last three censuses, whether measured by its infant 
mortality rate to births or to living population under age 1, 
is at least worthy of note. 

Unfortunately, the figures of most of the registration States, 
so far as the infant death-rate to births is concerned, have been 
open to the suspicion of too glaring inaccuracies — at least up to 
a very recent period — to warrant any attempt to make com- 
parison between them and those of the European countries with 
long-established registration systems. But the census returns 
for these States in 1880, 1890, and 1900, herewith presented 
for what they are worth, are none the less worthy of a careful 
study from various view-points by those interested in the subject 
of infant mortality. 

In this paper the writer has aimed to supplement the work 
of the numerous medical experts, who have long been probing 
the puzzling problems of infant mortality, by bringing to- 
gether from various sources and presenting in compact form 
the most reliable statistical information now obtainable which 
would warrant some definite conclusions as to the rise or fall 
of the infant mortality rate in recent years throughout the 
world, and the apparent present tendencies of the infant death- 
rate. It has seemed possible that the presentation of specific 
information on these lines might provide sound foundations, 
in the way of authoritative facts and figures of international 
scope, for the widely extended movement now being earnestly 



40 

made for the reduction of the infant death-rate. If so, the 
purpose of this paper will have been served, and possibly in 
a later paper the writer may present some of the mass of data 
as to the fundamental causes for the abnormally heavy infant 
mortality in certain sections — and especially in certain factory 
towns — which have accumulated in his hands, but have been 
foreign to the purposes of this preliminary and purely statis- 
tical study of the far-reaching subject which is just beginning 
in these twentieth-century days to make its real importance 
felt. In the consideration of it, and of the almost innumerable 
problems involved in it, not only the prospective population, 
but the general welfare, of the entire civilized world are deeply 
concerned. As Dr. Alden has so gravely remarked, "A thor- 
ough understanding of the subject should be the concern of 
every true citizen." 



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